This matter was initiated by a complaint filed with the United States Department of Justice ("the Department") against Roger Williams Medical Center ("RWMC") in Providence, Rhode Island. The complaint was investigated by the Department under the authority granted by section 308(b)(1)(A)(i) of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. § 12188(b)(1)(A)(i).

At the time this complaint was initiated, RWMC was the sole member of Roger Williams Hospital, an acute care hospital system, operating primarily in Providence, Rhode Island. Roger Williams Hospital ("the hospital") is licensed to have 236 beds. The hospital is a "public accommodation" as defined in section 301(7)(F) of the ADA, 42 U.S.C. §12181(7)(F), and its implementing regulation, 28 C.F.R. § 36.104.

The Attorney General is authorized under section 308(b)(1)(B) of the ADA, 42 U.S.C.
§ 12188(b)(1)(B), to bring a civil action under title III in any situation where a pattern or practice of discrimination is believed to exist or where a matter of general public importance is raised. In consideration of the terms of this Agreement as set forth below, the Attorney General agrees to refrain from undertaking further investigation or from filing a civil suit under title III in this matter.

The parties have agreed to resolve this matter as set forth below without adjudication of any factual and legal disputes.

Remedial Action: Auxiliary Aids and Services

The hospital shall, within 30 days of the effective date of this Agreement, circulate broadly within the hospital a notice that, during normal business hours Monday - Friday, the Department Manager/Director grants approval for the procurement of auxiliary aids and services for people who are deaf or hard of hearing or who have a speech impairment, and, after normal business hours Monday - Friday and on weekends, the Nursing Supervisor grants approval for the procurement of auxiliary aids and services for people who are deaf or hard of hearing or who have a speech impairment. The notice will include all applicable contact information.

The hospital shall, within 30 days of the effective date of this Agreement, perform assessments of patients or their companions at the time an appointment is scheduled or
upon arrival of a patient or their companion, as part of each routine assessment to determine if an auxiliary aid or service is necessary for effective communication, and the hospital shall keep appropriate records that reflect these assessments.

The hospital shall ensure immediate hospital assistance by providing appropriate auxiliary aids and services necessary for effective communication as soon as practicable after determining that an auxiliary aid or service is necessary for effective communication. Such auxiliary aids or services may include the following:

paper and writing utensil,

visual aids,

written materials,

assistive listening devices and systems,

qualified sign language or oral interpreters.

The hospital shall provide to the patient or companion who is deaf or hard of hearing or who has a speech impairment the current status of efforts being taken to secure any appropriate auxiliary aid or service and reasonable updates until such aids and services are secured.
The hospital shall continue to try to communicate with the patient or his/her companion who is deaf or hard of hearing or who has a speech impairment for such purposes and to the same extent as they would have communicated with the person but for the hearing or speech impairment, using all available methods of communication, until the auxiliary aid or service becomes available.

Remedial Action: Sign Language and Oral Interpreters

The hospital is strongly encouraged, but shall have no obligation, to hire, retain, or otherwise contract with qualified interpreters to be considered as the hospital staff interpreters. To the extent that the hospital does not have staff interpreters or a staff interpreter is not available within one hour of a request, the hospital will follow the procedures set forth below to obtain the services of qualified interpreters.

The hospital shall, within 120 days of the effective date of this Agreement, enter into a signed contract with an interpreting service to be available to provide qualified sign language and oral interpreter services at the request of the hospital.

Each contract shall request the interpreting service to maintain a response time of one hour or less in the majority of non-scheduled incidents beginning fifteen minutes after an official request by the hospital.

The contracts shall collectively provide interpreting services twenty-four hours a day and seven days a week.

The hospital shall make reasonable efforts to contact a qualified interpreter from the interpreting services with whom the hospital has an ongoing contract for qualified sign language or oral interpreters until an appropriate interpreter is secured.

If a qualified interpreter cannot be secured, the hospital shall inform the patient or his/her companion who is deaf or hard of hearing or who has a speech impairment (or, if unavailable, the person's companions) of the efforts taken to secure a qualified interpreter and that the efforts have failed, and shall follow up on reasonable suggestions for alternate sources of interpreters, such as contacting and procuring an interpreter known to the patient or companion.

Remedial Action: Teletypewriters (TTY's)

The hospital shall, within 90 days of the effective date of this Agreement, make available a TTY in the Emergency Department and maintain at least one portable TTY's for use in patient rooms. If at any time both TTY's are in use simultaneously, or if there are no portable TTY's available for use for any reason, the hospital will purchase an additional TTY within 30 days. Furthermore, the hospital will continuously monitor usage of the TTY's and will purchase additional equipment as needed to meet demand if doing so does not impose an undue burden.

The hospital shall, within 90 days of the effective date of this Agreement, post signs complying with the Standards at all public visitor telephone locations that are not already equipped with a TTY. The signs shall indicate the location of the nearest portable or permanently installed TTY.

Remedial Action: General

The hospital shall, within 120 days of the effective date of this Agreement, post and maintain signs of conspicuous size and print at all the hospital admitting stations, the emergency department, and wherever a Patient's Bill of Rights is required by law to be posted. Such signs shall state:

Sign language and oral interpreters, TTY's, assistive listening devices, and other auxiliary aids and services are available free of charge as needed for effective communication. For assistance, please contact any hospital personnel or the Telecommunications Department at _________ (voice/TTY), room ________.

These signs shall include the international symbols for "interpreters" and "TTY's" (see attachment).

The hospital shall, within 90 days of the effective date of this Agreement, publicize in appropriate public areas of the hospital and include in all future printings of the hospital's Patient Handbook (or equivalent) and all similar publications a statement to the following effect:

"To ensure effective communication with patients and their companions who are deaf or hard of hearing or who have speech impairments, we provide appropriate auxiliary aids and services free of charge, such as: sign language and oral interpreters, TTY's, notetakers, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids and closed caption decoders, unless doing so will fundamentally alter the nature of the goods, services, facilities, privileges, advantages, or accommodations being offered.

Please ask your nurse or other hospital personnel for assistance, or contact the Telecommunications Department at _________________ (voice or TTY), room ___________________."

The hospital shall, within 90 days of the effective date of this Agreement, publish, in an appropriate form, a written policy statement regarding the hospital's policy for effective communication with persons who are deaf or hard of hearing or who have speech impairments, and shall distribute this document to all personnel and affiliated physicians (physicians with practicing or admitting privileges), and to all new personnel and newly affiliated physicians upon their employment or affiliation with the hospital. The policy statement shall include, but is not limited to, language to the following effect:

"If you recognize or have any reason to believe that a patient, or a relative, close friend or companion of a patient is deaf or hard of hearing or has a speech impairment, you must advise the person that appropriate auxiliary aids and services will be provided free of charge. If you are the responsible health care provider, you must make all reasonable efforts to ensure that such aids and services are provided when appropriate. All other personnel should direct that person to the appropriate Program Administrator. This offer and advice must likewise be made in response to any overt request for appropriate auxiliary aids or services."

Within 90 days of the effective date of this Agreement, the hospital shall provide in-service training to those personnel who work or volunteer in the Emergency Department, to address the available means of achieving effective communication with patients or their companions who are deaf or hard of hearing or who have speech impairments. Specific training objectives shall include promptly identifying communication needs and preferences of persons who are deaf or hard of hearing or who have speech impairments and quickly securing the services of a qualified sign language interpreter when necessary.

Within 180 days of the effective date of this Agreement, the hospital shall provide in-service training to admitting personnel, personnel with patient responsibility, and any other staff reasonably expected to communicate with patients or their companions, to address the available means of achieving effective communication with patients or their companions who are deaf or hard of hearing or who have speech impairments. Specific training objectives shall include promptly identifying communication needs and preferences of persons who are deaf or hard of hearing or who have speech impairments and quickly securing the services of a qualified sign language interpreter when necessary.
The hospital shall, within 90 days of the effective date of this Agreement, provide a complaint resolution mechanism regarding use of the hospital's goods, services, programs, and activities by patients or their companions who are deaf or hard of hearing or who have speech impairments and shall maintain records of all complaints filed and actions taken with respect thereto.

As a good faith gesture, the hospital shall, within 30 days of the effective date of this Agreement, send by certified mail, return receipt requested, a check to the individual complainant in the amount of $400.00. The hospital will also send by certified mail, return receipt requested, a check to the qualified sign language interpreter in the amount of $100.00. Simultaneous with the mailing of the checks, the hospital shall provide to the Department of Justice a copy of the checks for our records. These checks are not in any way to be construed as admittance of any form of discrimination on the part of the hospital but instead as an expression of their continued commitment to the ADA.

Reporting, Monitoring and Violations

The hospital will keep appropriate records to document each procurement of any auxiliary aids or services. The hospital shall provide such documentation to the Department upon reasonable written notice. Interpreter invoices to the hospital together with the hospital's inpatient admission form are appropriate.

Within six months of the effective date of this Agreement, the hospital will submit a report to the Department demonstrating that the agreed upon actions required by paragraphs 5 through 17 have been accomplished.

Enforcement

The Department of Justice may review compliance with this Agreement at any time. If the Department believes that this Agreement or any of its requirements has been violated, it may institute a civil action in federal district court to enforce this Agreement or the requirements of title III, following written notice to the hospital of possible violations and a period of ten days in which the hospital has the opportunity to cure the alleged violations.

Failure by the Department of Justice to enforce this entire Agreement or any of its provisions or deadlines shall not be construed as a waiver of the Department's right to enforce other deadlines and provisions of this Agreement.

Implementation

This Agreement is a public agreement. A copy of this document or any information contained in it may be made available to any person by the hospital or the Department on request.

The effective date of this Agreement is the date of the last signature below.
This Agreement constitutes the entire agreement between the parties on the matters raised herein, and no other statement, promise, or agreement, either written or oral, made by either party or agents of either party, that is not contained in this written Agreement, shall be enforceable. This Agreement does not purport to remedy any other potential violations of the ADA or any other federal law. This Agreement does not affect the hospital's continuing responsibility to comply with all aspects of the ADA.

This Agreement will remain in effect for one year from the effective date of this Agreement, or until the parties agree that full compliance with this Agreement by the hospital has been achieved.
The person signing this document for the hospital represents that he or she is authorized to bind the hospital to this Agreement.

The undersigned AGREE and CONSENT to the form and content of this Agreement: